"Conservatives realize that nowadays there's an engaged and vocal weight of opposition," Ehsani said. "The problem of sharing power with the rest of society cannot be delayed ad infinitum. At some point this has to be addressed.

"It can be addressed through sheer violence — Iran can try to do this, but I think it will fail badly because Iran is a politicized society. But on the other hand, the question of how you share power with people who have monopolized power until now but now are in danger of losing it to more pluralism — that's not an easy question."

As he sips his tea, Semnani chuckles. Despite the odds, he is optimistic about Iran's future — and most of all, he knows his faith won't let him abandon his dreams.

The medical clinic, named for Semnani's late grandmother Maliheh, opened in 2006. The clinic employs six paid employees who combine forces with a small army of volunteer nurses, doctors and medical students that collectively donated 16,000 hours during 2010. Semnani's schedule doesn't permit him to visit frequently, but he stays apprised of the comings and goings at Maliheh through regular meetings between his wife, Ghazaleh, and clinic executive director Jeanie Ashby.

Maliheh's can-do attitude isn't just a band-aid for people without other medical-care options — it's a literal lifeline. The clinic's never-say-never ethos is embodied in a creative, multifaceted program that ensures uninsured patients will receive the medications physicians prescribe for sustaining life or restoring quality of life.

The first line of defense for making sure patients get the medications they need is a laminated card found in every exam room that lists the generic prescriptions available at Wal Mart and Target for about $4. For conditions that can't be treated with a generic drug from the laminated reference card, a clinic staffer is available to help people fill out the lengthy application forms for drug companies' patient-assistance programs. If all else fails, doctors can send a patient in dire need of a specific, expensive medication to Rite Aid — where Maliheh has a running tab that the an anonymous donor pays off in full.

Presently, Maliheh is in the midst of a thorough remodeling to increase its patient capacity beyond the 80-100 people who come on a daily basis for free medical services. Still, the clinic simply does not come close to meeting demand for healthcare services among Salt Lake City's underinsured. Indeed, the waiting list to become a new patient at Maliheh currently requires about 3-5 months.

But sheer numbers aren't the endgame at Maliheh.

"We're running as fast as we can and pinching every penny along the way, but it won't meet all the need," Ashby said. "We just have to look at each starfish on the sand and say, 'made a difference for that one,' and make a difference for as many people as we can."

Although Ashby finds herself perpetually juggling supplies, staff and schedules, she can't imagine having it any other way.

"Every day I get to talk to people who are grateful that we're here, and it just makes me feel good," Ashby said. "But the Semnanis are who really need to be thanked. The contribution that they make to the clinic and to the community is unequivocal — nobody does that."

Khosrow Semnani timeline

1947: born in Mashaad, Iran

1968: emigrated to the U.S.

1977: earned master's degree in engineering administration from University of Utah